Provider Demographics
NPI:1528582368
Name:KEEM, KANGHYUN (DDS)
Entity Type:Individual
Prefix:
First Name:KANGHYUN
Middle Name:
Last Name:KEEM
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6141 HIGH BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20720-5216
Mailing Address - Country:US
Mailing Address - Phone:301-801-6404
Mailing Address - Fax:301-262-8609
Practice Address - Street 1:6141 HIGH BRIDGE RD
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20720-5216
Practice Address - Country:US
Practice Address - Phone:301-801-6404
Practice Address - Fax:301-262-8609
Is Sole Proprietor?:No
Enumeration Date:2017-08-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD16515122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist